The Primer provides a rapid guide to the most interesting comment and analysis on the English health and care sector that has not (usually) appeared in HSJ.
It’s been widely reported that the government is this week hoping to deliver a major health and social care double-serving funding announcement.
On Monday morning, reports from the BBC and elsewhere suggest government has just confirmed £5.5bn additional NHS funding for the second half of 2021-22.
The Telegraph, Times, Mail and others report that the prime minister may announce the long-promised cap on care costs, along with a national insurance rise to pay for it, and at the same time cancelling the pensions uplift triple-lock, giving pensioners a smaller rise.
These plans have set off much opposition, unsurprisingly, both from those opposed to an NI rise and pensions U-turn, and those in the care sector who fear the proposals are not going to go very far by way of actually improving social care.
The same announcement is due to also cover NHS funding, settling the next three years revenue.
NHS Providers and the NHS Confederation pushed back hard last week as they believed what was being offered in 2022-23 was £5bn short of what is needed.
The Sunday Times indicates the prime minister had been persuaded — planning to meet the full £10bn plea above the underlying settlement for three years from 2022-23 — but that Chancellor Rishi Sunak may be still holding out against this.
The paper reports: “Despite talks involving Johnson, Rishi Sunak, the chancellor, and Sajid Javid, the health secretary, that went on until 1am on Saturday, and resumed in the afternoon, the two sides remained ‘several billion pounds’ apart. ‘This is going to go to the wire,’ a No 10 source said.”
Ex-NHS chief Lord Stevens was known for his brinkmanship on funding deals. This will be the first settlement/stand-off with the NHS under Amanda Pritchard.
If the Treasury does meet the £10bn annual ask, supplemented by say £5.5bn for the rest of 2021-22, it would of course be spun cumulatively as a £35.5bn gift for the NHS.
Rolling the NHS together with social care also raises concern that social care will again be sold short. The Sunday Times explains the plan: “The Treasury has calculated that some of the money being allocated to pay for social care can be used in the first couple of years for NHS catch-up services, since the social care costs will only increase slowly.”
But the chances of the NHS being able to clear the elective backlog in the two-year window envisaged, or of realistically freeing up the money in future years, are pretty slim.
Hence the Times leader on Saturday warned Boris Johnson he “must not allow the NHS to suck up the extra cash without reforming itself”.
Message in a bottle
The blood bottle shortage begins and, hot on the heels of other shortages issues — PPE, testing supplies — the soul searching/lobbying has begun over what lessons must be learned from it.
The HCSA, representing healthcare procurement specialists, says the NHS has for “many years… placed a greater emphasis on cost efficiency, driving initiatives focused on supplier aggregation and rationalisation” — whereas this shows the need to invest in “supply chain resilience and supplier relationship management”.
Going further, it says the dominance of BD as a supplier has caused problems, highlighting a need for diverse suppliers, and “more supply that is directly under NHS control”.
“We had a lot of these procurement problems during the pandemic and we, the NHS, need to consider storing more of these products in the UK so we can be more resilient,” said HCSA chair Mark Roscrow.
The Institute of Biomedical Science, speaking for the key group in the labs, took last week to have its say, too. It agrees with some of the procurement sentiment: “The UK’s pathology services (in England, Scotland and Wales) are experiencing major disruptions to their supplies of blood test tubes due to the ‘just in time’ manufacturing model and an over reliance on a limited number of suppliers of the test tubes.”
However it also gets into the sensitive issue of pathology networking: “The supply issues with Becton Dickinson emphasise the need for pathology services to work in a more co-ordinated way, within networks with clear leadership structures, to ensure that the supplier base is wide, and so that pooled and shared resources can prevent significant disruption and mitigate the risk when issues do occur.”
And it warns that the shortages “will have an impact on the wider NHS recovery from the COVID-19 pandemic response and this will need to be factored in as pathology, phlebotomy and primary care services need to be supported accordingly”.
Catching up with the guidance
With integrated care systems due to become statutory in just eight months, NHS England guidance for them is coming thick and fast. It is not full of tough new rules (watch the ongoing legislative process for those to emerge), but does require ICSs to put time into developing various policies and plans.
Documents this week cover:
- Developing place-based partnerships
- Working with people and communities
- Clinical and care professional leadership
- Partnerships with the voluntary, community and social enterprise sector
Meanwhile, with parliament returning this week, the Commons will get into its detailed committee stages on the Health and Care Bill. So far proposed amendments are interesting (see article from Karin Smyth on her’s) but relatively limited. We may soon find out if Sajid Javid wants to be flexible on the main contentious points like grabbing new powers to direct reconfigurations.
The Center for Policy Studies, meanwhile, is trying to encourage him to slow down the whole set of integration reforms, arguing in a report published at the weekend that there have not been major benefits from integration forerunners like Greater Manchester.